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General NPI Number Information
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NPI Number | 1255473005
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Entity Type | Organization
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Legal Business Name | MADISON EYE CARE ASSOCIATES INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 26927 DETROIT RD
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City | WESTLAKE
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State | OH
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Zip | 44145-2370
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Country | US
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Telephone | 440-892-5367
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Fax | 440-249-5094
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Provider Business Mailing Address
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Address Line | 26927 DETROIT RD
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City | WESTLAKE
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State | OH
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Zip | 44145-2370
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Country | US
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Telephone | 440-892-5367
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Fax | 440-249-5094
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER V. MOGYORDY
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Credential | O.D.
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Telephone | 440-892-5367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5484
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3207
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4481
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License Number State | OH
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